Name: muscle function obtained with motion mode ultrasound and surface electromyography during core endurance exercise
Uploaded: 2022-08-25T14:45:00.000+00:00
Duration: 9 min 21 s
Description: Watch this Scientific Journal Video about Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise at JoVE.com

All human participants provided informed consent. The protocol was part of a study approved by the Institutional Review Board of the University of Central Florida. Inclusion criteria included ages 18 -45 and physically active according to ACSM guidelines (30 min of moderate to vigorous activity 5 days per week)19. Exclusion criteria included low back pain within the past year, current hip, upper, or lower extremity pain or injury, a year history of low back surgery or lower extremity surgery, self-reported balance disorder, muscular abnormalities, currently pregnant, or having an open wound in the abdominal area (Table 1).
1. Data collection instrument preparation
<ol>
	<li>Check the integrity of the ultrasound machine and sEMG machine (see Table of Materials).
	<ol>
		<li>Turn on the ultrasound machine, press Patient, and add a new patient. Click New Patient and enter the patient identification number. Select MSK exam type &#62; Abdominal preset and press Register. Press Exit.</li>
		<li>Turn on the tablet (see Table of Materials) and click the EMG recording application. Click the Menu button in the top left screen and scan for sensors. Take the sensor out of the base and hover over the activation button. Once the sensor is connected with the application, create a new folder with the participant&#39;s identification number. 
		NOTE: Ultrasound settings in Abdominal Preset, B-mode: B color = Tint Map D, Write Zoom Height = 4, Write Zoom Width = 4, Thermal Index = Tls, ATO Level = Low, Focus Number = 2, Focus Number CrossXBeam = 2, Focus Depth = 50, Depth (cm) = 3, Compression = 1, Focus Width = 1, Focus Width CrossXBeam = 1, Line Density = 3, Line Density CrossXBeam = 3, Suppression = 0, Frame Average = 4, From Average CrossXBeam = 2, CrossXBeam = 2, CrossXBeam # = Low, CrossXBeam Type = Mean, Edge Enhance = 3, B Steer = 0, Gray Scale Map = Gray Map C, Gain = 34, Dynamic Range = 69, Rejection = 0, Frequency (MHz) = 12. Ultrasound settings in Abdominal Preset, M-mode: sweep speed = 0, M color = Tint Map C, Dop Display Format = Vert &#189; B, Rejection = 0, Compression = 1, Gray Scale Map = Gray Map D, M Gain (delta from B) = 0.</li>
	</ol>
	</li>
</ol>
2. Surface electromyography preparation (see Table of Materials)
<ol>
	<li>Determine the external oblique sensor location by palpating the right iliac crest and right inferior rib while the participant is supine hook-lying (Figure 1). Place the sensor 3 cm anterior from the midway point between the lower rib and the iliac crest, parallel to the muscle fibers20.</li>
	<li>Shave, clean, and debride the area of the skin where the sensor (see Table of Materials) will be placed. Add adhesive (see Table of Materials) to the sensor and secure onto skin.</li>
</ol>
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/64335/64335fig01.jpg" /> 
Figure 1: Examination location of the lateral abdominal wall. The sEMG sensor is placed 3 cm anterior from the midway point between the lower rib and the iliac crest, parallel to the muscle fibers20.&#160;The transducer is located 10 cm lateral to the umbilicus until the lateral abdominal wall is visible on the screen. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
3. Ultrasound preparation (see Table of Materials)
<ol>
	<li>In a standing position, place the transducer through the elastic belt and foam block (Figure 2).</li>
	<li>Add gel to the transducer and place the transducer 10 cm lateral to the umbilicus. Adjust until the lateral abdominal wall is visible on the screen21 (Figure 3).</li>
	<li>Ensure that the transducer is tightly secured to the lateral abdominal wall.</li>
	<li>Secure the belt with the velcro straps. Adjust the depth to obtain optimal image quality in B-Mode (Figure 4).</li>
</ol>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/64335/64335fig02.jpg" /> 
Figure 2: Transducer placed through the elastic belt and foam block. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/64335/64335fig03.jpg" /> 
Figure 3: Example of resting image to verify the lateral abdominal wall. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/64335/64335fig04.jpg" /> 
Figure 4: Transducer secured on the lateral abdominal wall by the elastic belt and foam block. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
4. Ultrasound static side plank
<ol>
	<li>On a yoga mat (see Table of Materials), instruct the participant to lay on their right side with their elbow in 90 degrees of flexion, so their trunk and upper extremity are raised off the ground. The participant&#39;s feet should be stacked on each other with the knees fully extended. The legs should be parallel touching the yoga mat.</li>
	<li>Press Freeze then Store for each image to capture three static ultrasound images of the lateral abdominal wall. 
	NOTE: Saved images will be located below the active image screen.</li>
</ol>
5. sEMG static side plank
NOTE: Simultaneously, the researcher will also obtain the sEMG output during the static positioning described in step 4.1.
<ol>
	<li>In the sEMG menu in the top left screen of the EMG recording application, select Settings, which is a gear icon.
	<ol>
		<li>Once in the sensor settings page, select the bicep icon. This will open the page for normalization measurements.</li>
		<li>Press Click Play to Begin; there will be a 5 s countdown. During this period, instruct the patient to assume the testing position. The recording will take an additional 5 s.</li>
		<li>Record the &#34;MVC = .XXXXmV&#34;, as this will be used for normalization calculation. 
		&#8203;NOTE: The EMG mobile suite automatically band pass filters between 20 -450 Hz. EMG (RMS) 333.3, 1125 ms window width.</li>
	</ol>
	</li>
</ol>
6. Side plank
<ol>
	<li>Next, instruct the participant to complete the side plank for 60 s maintaining the correct form22. Press the M on the ultrasound machine to turn on M-mode.</li>
	<li>Press Plot, press the red button and press the Save button again in the EMG application. The participant will be given a 3 s countdown. Once that countdown commences, press Store on the ultrasound to begin the ultrasound recording. 
	NOTE: The participant will hold the correct form until 60 s, or when the researcher determines that the correct form has been disrupted.</li>
	<li>To save the recorded M-mode video, press Store once the exercise has stopped and the Stop button on the sEMG application.</li>
	<li>Click Save file as and type in a filename to save the output, which will appear on the screen when the recording is stopped.</li>
</ol>
7. Ultrasound static dead bug
<ol>
	<li>On the yoga mat, instruct the participant to lay supine with their legs in a hook-lying position.</li>
	<li>Press B to enter brightness mode. Press&#160;Freeze and then Store for each image to capture three static images of the lateral abdominal wall via ultrasound. Saved images will be located below the active image screen.</li>
</ol>
8. sEMG static dead bug
<ol>
	<li>In the menu of the EMG application (top left), select Settings, which is a gear icon.</li>
	<li>Once in the sensor settings page, select the bicep icon. This will open the page for normalization measurements.</li>
	<li>Press Click Play to Begin. During the 5 s countdown, instruct the patient to assume the testing position. The recording will take an additional 5 s.</li>
	<li>Record the &#34;MVC = .XXXXmV&#34;, as this will be used for normalization calculation.</li>
</ol>
9. Dead bug
<ol>
	<li>Next, instruct the participant to complete the dead bug for 60 s, maintaining the correct form. Press the M on the ultrasound machine to turn on M-mode.</li>
	<li>Instruct the participant to maximally extend their right shoulder while maximally extending their left hip and knee, while also maintaining the starting position of the contralateral extremities.</li>
	<li>Instruct the participant to then flex their shoulder, hip, and knee to return to the starting position. The contralateral extremities will then perform the same motion.</li>
	<li>Ask the participant to perform the exercise to a metronome set to 45 beats per min. This results in 22 repetitions of the dead bug in 60 s. 
	NOTE: The participant should hold the correct form until 60 s, or until the researcher determines that the correct form has been disrupted or the metronome rhythm has been interrupted.</li>
	<li>Press&#160;Plot, press the&#160;red&#160;button and then press Play. Press the&#160;Save&#160;button again in the EMG application.&#160;The participant will be given a 3 s countdown. Once that countdown commences, press Store on the ultrasound to begin the ultrasound recording.</li>
</ol>
10. Ultrasound static measurement
<ol>
	<li>Click Enter when the first static image you want to measure is selected.</li>
	<li>Press Measure to open the measurement tool. Measure the maximal muscle thickness during the static positions in centimeters from the superior inferior fascial border to the inferior superior fascial border (Figure 5 [side plank] and Figure 6 [dead bug]).</li>
	<li>Click Enter at the superior inferior border and Enter again at the inferior superior border.</li>
	<li>Repeat steps 10.1-10.3 for side plank and dead bug static measurements. Average the measurements of the three static images.</li>
</ol>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/64335/64335fig05.jpg" /> 
Figure 5: Example of lateral abdominal wall during the side plank static, exercise starting position and measurements of muscles. A = external oblique (0.554 cm), B = internal oblique (0.761 cm), and C = transverse abdominis (0.326 cm). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/64335/64335fig06.jpg" /> 
Figure 6: Example of lateral abdominal wall in the dead bug static, exercise starting position and measurements of muscles. A = external oblique (0.618 cm), B = internal oblique (0.820 cm), and C = transverse abdominis (0.438 cm). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig06large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
11. Ultrasound dynamic measurements
<ol>
	<li>Measure the maximal thickness of the external oblique, internal oblique, and transverse abdominis thickness during the first 5 s and last 5 s of the exercise. Additionally, record the maximal thickness over the entire 60 s. 
	NOTE: The side plank is commonly performed for durations of 5 s. Taking sets and repetition guidelines from previous authors, a longer duration of 60 s was chosen for comparison in this protocol. The first 5 s and last 5 s of the task were compared to evaluate both the strength and endurance aspects of the muscle group23,24.</li>
	<li>Using the Scroll button, find the first 5 s and last 5 s of each exercise. Additionally, visually inspect for the greatest thickness of each muscle throughout the 60 s exercise.</li>
	<li>Press Measure to open the measurement tool. Measure the maximal muscle thickness during the static positions in centimeters from the superior inferior fascial border to the inferior superior fascial border (Figure 7 [side plank] and Figure 8 [dead bug]).</li>
	<li>Divide each of the three thickness measurements obtained during the exercises by the averaged static position to obtain an activation ratio 25.</li>
</ol>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/64335/64335fig07.jpg" /> 
Figure 7: Example of lateral abdominal wall during the side plank exercise and measurements of muscles in M-mode. A = external oblique (0.968 cm), B = internal oblique (0.937 cm), and C = transverse abdominis (0.714 cm). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig07large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/64335/64335fig08.jpg" /> 
Figure 8: Example of lateral abdominal wall during the dead bug exercise and measurements of muscles in M-mode. A = external oblique (0.840 cm), B = internal oblique (0.840 cm), and C = transverse abdominis (0.720 cm). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/64335fig08large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
12. sEMG Measurement
<ol>
	<li>Press the Home icon on the EMG data recording page. Select the folder icon in the top right corner of the screen. The saved output from the static and exercise trials will be saved here. Convert each file to an .xlsx file. Export the .xlsx file.</li>
	<li>In a spreadsheet, obtain the maximum values during the first and last 5 s, and the overall maximum value.</li>
	<li>Divide the static sEMG output obtained in steps 5 (static side plank sEMG) and 8 (dead bug sEMG) by the output during the exercises, respectively.</li>
</ol>

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The authors declare no conflicts of interest related to this manuscript.

M-mode ultrasound provides onset of muscle tissue movement and muscle thickness change during real time observation of anatomy over a selected time21. M-mode ultrasound combined with sEMG provides an overall understanding of muscle function, including electrical representation and visual observation. These instruments can be used in tandem during exercise to provide researchers with a global understanding of muscle function.
Specific training of ultrasound and sEMG techniques is necessary to produce reliable and valid measurements. Normalization methods used with M-mode ultrasound and sEMG need to be similar in order to compare instruments (i.e., static, exercise starting position)26.
A modification may be needed for the foam block used to secure the transducer based on the participant&#39;s body size. The tightness of the elastic belt will also need to be modified depending on the participant&#39;s body size. The transducer may slightly move from the original positioning during movement before or after exercise. It is important to continue to monitor the image of the lateral abdominal wall on the ultrasound screen throughout the data collection process. Ample amount of ultrasound gel is needed to ensure clear imaging, but too much can interfere with the sEMG sensor adhesive. Modification of the optimal amount of ultrasound gel used is important throughout data collection.
A limitation of both instruments is that they only represent the anatomy directly beneath the sEMG sensor and ultrasound transducer due to the limited broadcast area for each. Assumptions are commonly made that the anatomy directly beneath the sensor still provides an adequate representation of the muscle27,28.
M-mode ultrasound provides an efficient way to detect onset of muscle activation and muscle thickness change throughout the duration of an exercise21. This one-dimensional live image of anatomy over time is helpful to understand change of muscle thickness during a task. M-mode ultrasound can be further complemented with an additional instrument such as sEMG to provide a total understanding of muscle function. Brightness mode should still be used to measure muscle thickness; however, during dynamic exercise, M-mode ultrasound may be alternatively beneficial. The use of M-mode ultrasound can be used during prevention and rehabilitation exercises in healthy and pathological individuals18. Trunk strengthening, increasing endurance, and specific trunk muscle activation are recommended for individuals with acute and chronic low back pain. M-mode ultrasound can be used during exercises that target the aforementioned recommendations to observe onset of activation, muscle thickness at certain exercise time points, and change in thickness.
The correlation between the two instruments was not examined in the current protocol. However, previous studies have noted that comparisons between the two instruments should be used with caution. Ultrasound has been shown to detect onset of muscle activation before electromyography, supporting the idea that these two instruments measure different aspects of muscle function29.
These methods are appropriate for application if the goal is to measure the onset of muscle activation as well as muscular thickness during exercise. As M-mode ultrasound provides a visual representation of the involved muscle, sEMG will compliment this assessment with the electrical representation of the muscle. The % MVIC of an individual during exercise may not change over time or post intervention; in such a scenario, M-mode ultrasound can supplement sEMG to assess the thickness change7,10. Although ultrasound images have been used in both modes to describe muscle movement for many years, this protocol details a more recent dynamic application that can have a direct impact on the use of ultrasound not only in research and highly controlled environments, but importantly in clinical practice with active individuals and in sport.

The lateral abdominal wall is made up of the transverse abdominis, internal oblique, and external oblique1. The lateral abdominal wall contracts concentrically, eccentrically, and isometrically to withstand the forces placed on the body1. The co-contraction of this muscle group provides stabilization of the center of the human body2,3. These muscles are important during the prevention and rehabilitation of lower extremity injuries because poor trunk function is associated with increased hip adduction and knee valgus, which are risk factors for lower extremity injuries4,5. Focusing on strengthening and increasing muscular endurance of the core musculature not only decreases risk factors for the lower extremity but can also decrease low back pain6. Recently, it has been recommended that individuals who are suffering from acute and chronic low back pain should include trunk strengthening, endurance, and specific trunk muscle activation in their rehabilitation6. An example of specific trunk muscle activation is targeting isolated or grouped trunk muscles using co-contraction to restore control or increase coordination of the lumbopelvic-hip region6.
Two ways to objectively measure muscle function are the use of motion mode (M-mode) ultrasound and surface electromyography (sEMG). M-mode ultrasound provides a real-time visualization of muscle and fascia movement during a recorded time which can display onset and extent of the motion7. The distance between the superior inferior fascial border and inferior superior fascial border are measured at a selected time to obtain muscle thickness. Muscle thickness during a specific time point of an exercise can be divided by resting thickness to achieve an activation ratio8. sEMG provides insight into muscle activation and fatigue, as the output can be compared to the muscle&#39;s maximum contraction9. These two instruments and methods have been used previously to measure the onset of hip muscle activation during a variety of exercises in healthy and injured individuals10. Exercises that target the trunk, and specifically the lateral abdominal wall, are the side plank and dead bug11,12,13. The side plank is performed in a side lying position with the elbow directly underneath the shoulder and forearm on the ground, the hips are raised off the ground until the spine is in a neutral position. The knees are extended, and the feet are placed on top of one another9 (Supplemental Figure 1). The dead bug is performed in a supine position with both arms straight above and the hips and knees flexed in a 90&#176; angle. The exercise begins when one arm is flexed above the head and the contralateral leg extends. The opposite arm and leg remain in a neutral position and then flex and extend once the original moving arm and leg return to the neutral position13 (Supplemental Figure 2 and Supplemental Figure 3).
The activation of the external oblique has been seen to range from 37% to 62% of maximum voluntary isometric contraction (MVIC) during the side plank11,12,14. During the dead bug, the activation of the external oblique has been recorded between 20% to 30% of MVIC for only five repetitions of the exercise15. The internal oblique and transverse abdominis, the deeper abdominal muscles of the lateral abdominal wall, activate between 22% to 28% of MVIC during the side plank12,14. Due to the overlapping nature of the internal oblique and transverse abdominis, the two muscles have been combined during sEMG collection14. A limitation of sEMG is the crosstalk from adjacent muscles, where the sEMG sensor may be producing an output of a different muscle, resulting in a false understanding of activation16. Muscle thickness measurements obtained with ultrasound can be used to mitigate this limitation, and this measurement is feasible during trunk exercises, such as the isometric holds previously mentioned17.
Muscle thickness of the lateral abdominal wall has been recorded during the side plank as an absolute magnitude of difference between contracted thickness and rested thickness. At the 30 s time point of a side plank, the muscle thickness of the internal oblique and external oblique increased by 0.526 mm and 0.205 mm, respectively17. These measurements were recorded in brightness mode ultrasound at one time point during the side plank. B-mode ultrasound is commonly performed to assess before and after images; however, this method only allows for measurement at two time points18. M-mode ultrasound provides increased advantages compared to B-mode ultrasound, as it can detect onset of muscle activation as well as muscle thickness during the entirety of the exercise with any time point able to be selected for measurement18. Therefore, the overall goal of the current protocol is to provide an innovative and practical measurement of muscle function with M-mode ultrasound and sEMG during core endurance exercises. This is beneficial to researchers and clinicians to understand how muscles function throughout the duration of an exercise, especially of an endurance nature, as opposed to a measurement isolated to a single time point.

<table><tbody><tr><td>Alcohol prep pads</td><td>Henry Schein</td><td>HS1007</td><td></td></tr><tr><td>Amazon Basics 1/2- Inch Extra Thick Exercise Yoga Mat</td><td>Amazon</td><td>YM2001BK</td><td></td></tr><tr><td>Delsys Trigno Sensor Adhesive Interface, 4-Slot</td><td>Delsys</td><td>SC:F03</td><td></td></tr><tr><td>Delsys Trigno Wireless System</td><td>Delsys</td><td>T03-A16014</td><td></td></tr><tr><td>Galaxy Tablet S5e</td><td>Samsung</td><td>SM-TS20N</td><td></td></tr><tr><td>GE NextGen Logig e Ultrasound Unit</td><td>GE Healthcare</td><td>HR48382AR</td><td></td></tr><tr><td>Linear Array Probe</td><td>GE Healthcare</td><td>H48062AB</td><td></td></tr><tr><td>Trigno Avanti sensors</td><td>Delsys</td><td>T03-A16014</td><td></td></tr></tbody></table>

muscle function obtained with motion mode ultrasound and surface electromyography during core endurance exercise

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured between fascial borders at a given time point during an exercise. This selected time point produces a one-dimensional image resulting in real-time, live observation of anatomy. Ultrasound used during functional movement can be referred to as dynamic ultrasound; this is feasible and reliable with the use of a linear transducer, elastic belt, and foam block to secure consistent transducer placement. The lateral abdominal wall is commonly investigated using ultrasound due to the overlapping nature of the muscles. Surface electromyography (sEMG) can complement M-mode ultrasound imaging because it measures the electrical representation of muscle activation. There is minimal evidence using M-mode ultrasound and sEMG simultaneously during core exercise. Exercises that challenge the core musculature involve both isometric holds (e.g., side plank), as well as oscillatory extremity movements (e.g., dead bug). In this study, both instruments will be used simultaneously to measure core muscle function during exercise. Ultrasound measurements will be obtained using a linear transducer and ultrasound unit, and sEMG measurements will be acquired from a wireless sEMG system. To make comparisons between participants and exercises, normalization methods using static, exercise starting positions for both instruments will be used. An activation ratio will be used for ultrasound and calculated by dividing the contracted thickness (thickness during a time point of exercise) by the rested (starting position) thickness. Muscle thickness will be measured in centimeters from the superior inferior fascial border to inferior superior fascial border. These methods aim to offer an innovative and practical measurement of muscle function with M-mode ultrasound and sEMG during core endurance exercises.

The measurements of both ultrasound and sEMG during the static, exercise starting position are represented in Table 2. These numbers will be used as the denominator when calculating the activation ratio. The thickness values of external oblique, internal oblique, and transverse abdominis during the first 5 s, last 5 s, and total duration (60 s) are in Table 3. These numbers are divided by the numbers in Table 2. The sEMG values normalized to static, exercise starting position during the first 5 s, last 5 s, and peak activity are presented in Table 4.
The activation ratio describes the magnitude of increase in the muscle thickness as a result of the exercise compared to the static, exercise starting position. For example, if the external oblique during the side plank had an activation ratio of 1.73, that means the muscle thickness increased by 73% during the exercise. The activation ratios for the external oblique, internal oblique, and transverse abdominis are summarized in Table 5. Use of the activation ratio allows researchers and clinicians to determine the extent of change in muscle thickness in a variety of exercises and positions26. Collection of ultrasound images with M-mode also allows for synchronization of timing to determine the onset of activation and corresponding thickness at the time of onset7.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Demographics</td>
			<td></td>
		</tr>
		<tr>
			<td>Age</td>
			<td>22.75 &#177; 4.94 years</td>
		</tr>
		<tr>
			<td>Height</td>
			<td>169.25 &#177; 6.88 cm</td>
		</tr>
		<tr>
			<td>Mass</td>
			<td>67.32 &#177; 4.94 kg</td>
		</tr>
	</tbody>
</table>
Table 1: Patient demographics.&#160;
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Exercise</td>
			<td>First 5 s</td>
			<td>Last 5 s</td>
			<td>Peak Activity</td>
		</tr>
		<tr>
			<td>TESP</td>
			<td>0.01499725 mV</td>
			<td>0.019264 mV</td>
			<td>0.021207 mV</td>
		</tr>
		<tr>
			<td>Dead bug</td>
			<td>0.02534 mV</td>
			<td>0.021346 mV</td>
			<td>0.02534 mV</td>
		</tr>
	</tbody>
</table>
Table 2: sEMG peak activity during first 5 s, last 5 s, and overall peak. EO = external oblique, IO = internal oblique, mV = millivolts, TrA = transverse abdominis.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Exercise</td>
			<td colspan="3">Static, Exercise Starting Thickness</td>
			<td>Static, Exercise Starting sEMG</td>
		</tr>
		<tr>
			<td></td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
			<td>EO</td>
		</tr>
		<tr>
			<td>TESP</td>
			<td>0.554 cm</td>
			<td>0.761 cm</td>
			<td>0.326 cm</td>
			<td>0.0059 mV</td>
		</tr>
		<tr>
			<td>Dead bug</td>
			<td>0.618 cm</td>
			<td>0.82 cm</td>
			<td>0.438 cm</td>
			<td>0.0029 mV</td>
		</tr>
	</tbody>
</table>
Table 3: Thickness and peak sEMG activity during the static side plank and dead bug exercise starting positions. cm = centimeters, EO = external oblique, IO = internal oblique, TrA = transverse abdominis.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Exercise</td>
			<td colspan="3">First 5 s</td>
			<td colspan="3">Last 5 s</td>
			<td colspan="3">Peak Thickness</td>
		</tr>
		<tr>
			<td></td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
		</tr>
		<tr>
			<td>TESP</td>
			<td>0.96 cm</td>
			<td>1 cm</td>
			<td>0.73 cm</td>
			<td>0.91 cm</td>
			<td>0.93 cm</td>
			<td>0.58 cm</td>
			<td>0.98 cm</td>
			<td>1 cm</td>
			<td>0.73 cm</td>
		</tr>
		<tr>
			<td>Dead bug</td>
			<td>0.61 cm</td>
			<td>0.82 cm</td>
			<td>0.43 cm</td>
			<td>0.56 cm</td>
			<td>0.79 cm</td>
			<td>0.38 cm</td>
			<td>0.62 cm</td>
			<td>0.88 cm</td>
			<td>0.5 cm</td>
		</tr>
	</tbody>
</table>
Table 4: Muscle thickness during first 5 s, last 5 s, and overall thickest point during the side plank and dead bug exercises. cm = centimeters.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>First 5 s</td>
			<td></td>
			<td></td>
			<td>Last 5 s</td>
			<td></td>
			<td></td>
			<td colspan="2">Peak Thickness</td>
			<td></td>
		</tr>
		<tr>
			<td>Activation Ratio</td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
			<td>EO</td>
			<td>IO</td>
			<td>TrA</td>
		</tr>
		<tr>
			<td>Side Plank</td>
			<td>1.73</td>
			<td>1.31</td>
			<td>2.24</td>
			<td>1.64</td>
			<td>1.22</td>
			<td>1.78</td>
			<td>1.77</td>
			<td>1.31</td>
			<td>2.24</td>
		</tr>
		<tr>
			<td>Dead bug</td>
			<td>0.99</td>
			<td>1.00</td>
			<td>0.98</td>
			<td>0.91</td>
			<td>0.96</td>
			<td>0.87</td>
			<td>1.00</td>
			<td>1.07</td>
			<td>1.14</td>
		</tr>
	</tbody>
</table>
Table 5: Ultrasound activation ratios during the side plank and dead bug exercises. EO = external oblique, IO = internal oblique, TrA = transverse abdominis.
Supplemental Figure 1: TESP exercise positioning.&#160;TESP = torso elevated side support.&#160;<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/Supplemental Figure 1.pdf" target="_blank">Please click here to download this File.</a>
Supplemental Figure 2: Dead bug starting position. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/Supplemental Figure 2.pdf" target="_blank">Please click here to download this File.</a>
Supplemental Figure 3: Dead bug repetition. TESP = torso elevated side support. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/64335/Supplemental Figure 3.pdf" target="_blank">Please click here to download this File.</a>

Watch this Scientific Journal Video about Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise at JoVE.com

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

This protocol uses motion mode ultrasound and surface electromyography simultaneously to measure muscle function of the core. Muscle thickness and activation of the local stabilizers (e.g., transverse abdominis, internal oblique) and global movers (e.g., external oblique) is achievable during specific time points of the side plank and dead bug exercises.

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured ...

muscle-function-obtained-with-motion-mode-ultrasound-surface

Nanyang Technological University

Research

JoVE Journal

Medicine

3.1K Views.  University of Central Florida. Dit protocol geeft inzicht in hoe dynamische echografie kan worden geïmplementeerd in een klinische setting om spieren tijdens kernoefeningen te beoordelen. Het grote voordeel van deze techniek is dat beide instrumenten gelijktijdig gebruikt kunnen worden tijdens core oefeningen. Schakel om te beginnen het echoapparaat in, druk op Patiënt en voeg een nieuwe patiënt toe.Klik op Nieuwe patiënt en voer het patiëntidentificatienummer in. Selecteer MSK-examentype, klik vervolgens op ab...

Video: Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

Corticospinal Excitability Modulation During Action Observation

This study used the transcranial magnetic stimulation/motor evoked potential (TMS/MEP) technique to pinpoint when the automatic tendency to mirror someone else's action becomes anticipatory simulation of a complementary act. TMS was delivered to the left primary motor cortex corresponding to the hand to induce the highest level of MEP activity from the abductor digiti minimi (ADM; the muscle serving little finger abduction) as well as the first dorsal interosseus (FDI; the muscle serving index finger flexion/extension) muscles. A neuronavigation system was used to maintain the position of the TMS coil, and electromyographic (EMG) activity was recorded from the right ADM and FDI muscles. Producing original data with regard to motor resonance, the combined TMS/MEP technique has taken research on the perception-action coupling mechanism a step further. Specifically, it has answered the questions of how and when observing another person's actions produces motor facilitation in an onlooker's corresponding muscles and in what way corticospinal excitability is modulated in social contexts.

Single-pulse transcranial magnetic stimulation over the primary motor cortex, neuronavigation, and registration of electromyographic activity of hand muscles were used in this study to explore corticospinal excitability while participants were observing action sequences.

This study used the transcranial magnetic stimulation/motor evoked potential (TMS/MEP) technique to pinpoint when the automatic tendency to mirror someone ...

Behavior

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment (RMCA) in Individuals with Chronic Spinal Cord Injury

During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination is disrupted by spinal cord injury (SCI), control of respiratory muscles innervated below the injury level is compromised1,2 leading to respiratory muscle dysfunction and pulmonary complications. These conditions are among the leading causes of death in patients with SCI3. Standard pulmonary function tests that assess respiratory motor function include spirometrical and maximum airway pressure outcomes: Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Maximal Inspiratory Pressure (PImax) and Maximal Expiratory Pressure (PEmax)4,5. These values provide indirect measurements of respiratory muscle performance6. In clinical practice and research, a surface electromyography (sEMG) recorded from respiratory muscles can be used to assess respiratory motor function and help to diagnose neuromuscular pathology. However, variability in the sEMG amplitude inhibits efforts to develop objective and direct measures of respiratory motor function6. Based on a multi-muscle sEMG approach to characterize motor control of limb muscles7, known as the voluntary response index (VRI)8, we developed an analytical tool to characterize respiratory motor control directly from sEMG data recorded from multiple respiratory muscles during the voluntary respiratory tasks. We have termed this the Respiratory Motor Control Assessment (RMCA)9. This vector analysis method quantifies the amount and distribution of activity across muscles and presents it in the form of an index that relates the degree to which sEMG output within a test-subject resembles that from a group of healthy (non-injured) controls. The resulting index value has been shown to have high face validity, sensitivity and specificity9-11. We showed previously9 that the RMCA outcomes significantly correlate with levels of SCI and pulmonary function measures. We are presenting here the method to quantitatively compare post-spinal cord injury respiratory multi-muscle activation patterns to those of healthy individuals.

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment RMCA in Individuals with Chronic Spinal Cord Injury

The purpose of this publication is to present our original work on a multi-muscle surface electromyographic approach to quantitatively characterize respiratory muscle activation patterns in individuals with chronic spinal cord injury using vector-based analysis.

During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination ...

A Novel Application of Musculoskeletal Ultrasound Imaging

Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders.

We describe a new ultrasound-based vector tissue Doppler imaging technique to measure muscle contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities. This approach provides complementary measurements of dynamic muscle function and could lead to a better understanding of mechanisms underlying musculoskeletal disorders.

Ultrasound is an attractive modality for imaging muscle and tendon  motion during dynamic tasks and can provide a complementary methodological  approach ...

Integrating VR and Biosensors for Quantitative Motion-Muscle Activity Assessment

Setup for the Quantitative Assessment of Motion and Muscle Activity During a Virtual Modified Box and Block Test

The ability to move allows us to interact with the world. When this ability is impaired, it can significantly reduce one's quality of life and independence and may lead to complications. The importance of remote patient evaluation and rehabilitation has recently grown due to limited access to in-person services. For example, the COVID-19 pandemic unexpectedly resulted in strict regulations, reducing access to non-emergent healthcare services. Additionally, remote care offers an opportunity to address healthcare disparities in rural, underserved, and low-income areas where access to services remains limited. 
Improving accessibility through remote care options would limit the number of hospital or specialist visits and render routine care more affordable. Finally, the use of readily available commercial consumer electronics for at-home care can enhance patient outcomes due to improved quantitative observation of symptoms, treatment efficacy, and therapy dosage. While remote care is a promising means to address these issues, there is a crucial need to quantitatively characterize motor impairment for such applications. The following protocol seeks to address this knowledge gap to enable clinicians and researchers to obtain high-resolution data on complex movement and underlying muscle activity. The ultimate goal is to develop a protocol for remote administration of functional clinical tests. 
Here, participants were instructed to perform a medically-inspired Box and Block task (BBT), which is frequently used to assess hand function. This task requires subjects to transport standardized cubes between two compartments separated by a barrier. We implemented a modified BBT in virtual reality to demonstrate the potential of developing remote assessment protocols. Muscle activation was captured for each subject using surface electromyography. This protocol allowed for the acquisition of high-quality data to better characterize movement impairment in a detailed and quantitative manner. Ultimately, these data have the potential to be used to develop protocols for virtual rehabilitation and remote patient monitoring.

Author Spotlight: Enhancing Remote Rehabilitation with Virtual Reality and Electromyography

The protocol described here aims to enhance the quantitative evaluation of upper limb deficits, with the goal of developing additional technology for remote assessment both in the clinic and at home. Virtual reality and biosensor technologies are combined with standard clinical techniques to provide insights into the functioning of the neuromuscular system.

The ability to move allows us to interact with the world. When this ability is impaired, it can significantly reduce one's quality of life and ...

Engineering

Determining The Electromyographic Fatigue Threshold Following a Single Visit Exercise Test

Theoretically, the electromyographic (EMG) fatigue threshold is the exercise intensity an individual can maintain indefinitely without the need to recruit more motor units which is associated with an increase in the EMG amplitude. Although different protocols have been used to estimate the EMG fatigue threshold they require multiple visits which are impractical for a clinical setting. Here, we present a protocol for estimating the EMG fatigue threshold for cycle ergometry which requires a single visit. This protocol is simple, convenient, and completed within 15-20 min, therefore, has the potential to be translated into a tool that clinicians can use in exercise prescription.

This protocol describes the electromyographic fatigue threshold which demarcates between nonfatiguing and fatiguing exercise workloads. This information could be used to develop a more individualized training program.

Theoretically, the electromyographic (EMG) fatigue threshold is the exercise intensity an individual can maintain indefinitely without the need to recruit ...

Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation

Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels). The present protocol describes how this method can be used to stimulate the posterior tibial nerve that activates plantar flexor muscles. Percutaneous electrical nerve stimulation consists of inducing an electrical stimulus to a motor nerve to evoke a muscular response. Direct (M-wave) and/or indirect (H-reflex) electrophysiological responses can be recorded at rest using surface electromyography. Mechanical (twitch torque) responses can be quantified with a force/torque ergometer. M-wave and twitch torque reflect neuromuscular transmission and excitation-contraction coupling, whereas H-reflex provides an index of spinal excitability. EMG activity and mechanical (superimposed twitch) responses can also be recorded during maximal voluntary contractions to evaluate voluntary activation level. Percutaneous nerve stimulation provides an assessment of neuromuscular function in humans, and is highly beneficial especially for studies evaluating neuromuscular plasticity following acute (fatigue) or chronic (training/detraining) exercise.

We present a protocol to assess changes in neuromuscular function. Percutaneous electrical nerve stimulation is a non-invasive method that evokes muscular responses. Electrophysiological and mechanical properties of these responses permit the evaluation of neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels).

Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, ...

Neuroscience

3D Ultrasound Imaging: Fast and Cost-effective Morphometry of Musculoskeletal Tissue

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS images are constructed from calibrated freehand 2D B-mode ultrasound images, which are positioned into a voxel array. Ultrasound (US) imaging allows quantification of muscle size, fascicle length, and angle of pennation. These morphological variables are important determinants of muscle force and length range of force exertion. The presented protocol describes an approach to determine volume and fascicle length of m.&#160;vastus lateralis and m.&#160;gastrocnemius medialis. 3DUS facilitates standardization using 3D anatomical references. This approach provides a fast and cost-effective approach for quantifying 3D morphology in skeletal muscles. In healthcare and sports, information on the morphometry of muscles is very valuable in diagnostics and/or follow-up evaluations after treatment or training.

3D ultrasound imaging (3DUS) allows fast and cost-effective morphometry of musculoskeletal tissues. We present a protocol to measure muscle volume and fascicle length using 3DUS.

The developmental goal of 3D ultrasound imaging (3DUS) is to engineer a modality to perform 3D morphological ultrasound analysis of human muscles. 3DUS ...

Obtaining Quality Extended Field-of-View Ultrasound Images of Skeletal Muscle to Measure Muscle Fascicle Length

Muscle fascicle length, which is commonly measured in vivo using traditional ultrasound, is an important parameter defining a muscle&#8217;s force generating capacity. However, over 90% of all upper limb muscles and 85% of all lower limb muscles have optimal fascicle lengths longer than the field-of-view of common traditional ultrasound (T-US) probes. A newer, less frequently adopted method called extended field-of-view ultrasound (EFOV-US) can enable direct measurement of fascicles longer than the field-of-view of a single T-US image. This method, which automatically fits together a sequence of T-US images from a dynamic scan, has been demonstrated to be valid and reliable for obtaining muscle fascicle lengths in vivo. Despite the numerous skeletal muscles with long fascicles and the validity of the EFOV-US method for making measurements of such fascicles, few published studies have utilized this method. In this study, we demonstrate both how to implement the EFOV-US method to obtain high quality musculoskeletal images and how to quantify fascicle lengths from those images. We expect that this demonstration will encourage the use of the EFOV-US method to increase the pool of muscles, both in healthy and impaired populations, for which we have in vivo muscle fascicle length data.

This study describes how to obtain high quality musculoskeletal images using the extended field-of-view ultrasound (EFOV-US) method for the purpose of making muscle fascicle length measures. We apply this method to muscles with fascicles that extend past the field-of-view of common traditional ultrasound (T-US) probes.

Muscle fascicle length, which is commonly measured in vivo using traditional ultrasound, is an important parameter defining a muscle&#8217;s force ...

Providing Visual Biofeedback Using Brightness Mode Ultrasound During a Golf Swing

Using ultrasound biofeedback in conjunction with verbal cueing can increase muscle thickness more than verbal cueing alone and may augment traditional rehabilitation techniques in an athletic, physically active population. Brightness mode (B-mode) ultrasound can be applied using frame-by-frame analysis synchronized with video to understand muscle thickness changes during these dynamic tasks. Visual biofeedback with ultrasound has been established in static positions for the muscles of the lateral abdominal wall. However, by securing the transducer to the abdomen using an elastic belt and foam block, biofeedback can be applied during more specific tasks prevalent in lifetime sports, such as golf. To analyze muscle activity during a golf swing, muscle thickness changes can be compared. The thickness must increase throughout the task, indicating that the muscle is more active. This methodology allows clinicians to immediately replay ultrasound videos for patients as a visual tool to instruct proper activity of the muscles of interest. For example, ultrasound can be used to target the external and internal obliques, which play an important role in swinging a golf club or any other rotational sport or activity. This methodology aims to increase oblique muscle thickness during the golf swing. Additionally, the timing of muscle contraction can be targeted by instructing the patient to contract the abdominal muscles at specific time points, such as the beginning of the downswing, with the goal of improving muscle firing patterns during tasks.

Brightness mode ultrasound can be used to provide visual biofeedback of the muscles of the lateral abdominal wall during a golf swing. Post-swing visual and verbal instruction can increase the muscle activation and timing of the external and internal obliques.

Using ultrasound biofeedback in conjunction with verbal cueing can increase muscle thickness more than verbal cueing alone and may augment traditional ...

Performing In Vivo and Ex Vivo Electrical Impedance Myography in Rodents

Electrical impedance myography (EIM) is a convenient technique that can be used in preclinical and clinical studies to assess muscle tissue health and disease. EIM is obtained by applying a low-intensity, directionally focused, electrical current to a muscle of interest across a range of frequencies (i.e., from 1 kHz to 10 MHz) and recording the resulting voltages. From these, several standard impedance components, including the reactance, resistance, and phase, are obtained. When performing ex vivo measurements on excised muscle, the inherent passive electrical properties of the tissue, namely the conductivity and relative permittivity, can also be calculated. EIM has been used extensively in animals and humans to diagnose and track muscle alterations in a variety of diseases, in relation to simple disuse atrophy, or as a measure of therapeutic intervention. Clinically, EIM offers the potential to track disease progression over time and to assess the impact of therapeutic interventions, thus offering the opportunity to shorten the clinical trial duration and reduce sample size requirements. Because it can be performed noninvasively or minimally invasively in living animal models as well as humans, EIM offers the potential to serve as a novel translational tool enabling both preclinical and clinical development. This article provides step-by-step instructions on how to perform in vivo and ex vivo EIM measurements in mice and rats, including approaches to adapt the techniques to specific conditions, such as for use in pups or obese animals.

Performing In Vivo and Ex Vivo Electrical Impedance Myography in Rodents

This article details how to perform in vivo (using surface and needle electrode arrays) and ex vivo (using a dielectric cell) electrical impedance myography on the rodent gastrocnemius muscle. It will demonstrate the technique in both mice and rats and detail the modifications available, (i.e., obese animals, pups).

Electrical impedance myography (EIM) is a convenient technique that can be used in preclinical and clinical studies to assess muscle tissue health and ...

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

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